Causes and Treatment of Peripheral Neuropathy

Peripheral neuropathy is damage to nerves in the hands and feet. Some people often describe pain, numbness, or tingling in the affected nerves, while others feel a change in sensation that doesn't quite feel right, often described as having a sock or glove on all the time. The intensity of symptoms can range from mild tingling to the complete loss of the ability to feel pressure or pain. Painful diabetic peripheral neuropathy is the other extreme that produces severe sensory pain, burning, or tingling. A neurologist will be looking for the exact cause of your neuropathy, which will lead to a proper diagnoses and treatment.

The degree of neuropathy symptoms varies from person to person. Many have a slight or mild sense of pain, numbness, or tingling. Meanwhile other people find their lives are completely disrupted by the pain and sensations.

What is Neuropathy?

Diabetic neuropathy is one of the most common forms of neuropathy today. Diabetes mellitus is a condition that develops from prolonged elevated blood glucose levels. Overtime cells stop responding to insulin and blood glucose levels continue to rise. The elevated blood sugars eventually damage the small blood vessels that provide nutrients to the nerves. Since the blood vessels cannot provide adequate nutrients to nerves, nerve injuries do not properly heal and regenerate. In addition to blood vessels, elevated glucose levels also damage the nervous system.

Somatic nerves are the nerves that control muscles and motor nerves control the ability to contract muscles. Sensory nerves send signals from the touch, temperature, or pressure receptors in the body tissues back to the brain and spinal cord. Autonomic nerves send signals from the spine to the internal organs, blood vessels, heart, and lung. Autonomic neuropathy could result in altered internal organ function, such as increased blood pressure. Neuropathy may affect any of these nerves, becoming damaged and altering their functions. Complications of damaging nerves depends on which nerve is affected and the level of nerve damage. In some cases, symptoms of peripheral neuropathy develop after a crush or severe compression injury.

Symptoms of Neuropathic Pain

Polyneuropathy symptoms can develop quickly or over a slow period of time, from months to years. The intensity of symptoms and specific areas affected vary from patient to patient. The level of neuropathy symptoms varies; it can be mild in some cases and much more severe in others. In some cases only a single nerve front is affected, while in others multiple nerves are involved. Neuropathy most commonly affects the longest nerves in the body, which is why it is common in the feet. It also very commonly affects the small pain nerves.

What Nerves Can Be Damaged?

Neuropathy can develop in any nerve in the body. The most commonly discussed neuropathy is the pain in the hands and feet. These nerves also control our temperature sensation, which is why some people feel hot and cold changes or extreme sensitivity. Neuropathy can also develop in our motor neurons that control muscle contraction which disrupts muscle and joint movements. It can also happen in the autonomic nervous system that controls digestive, gut, or bowel and bladder functions.

A person can suffer from a peripheral neuropathy affecting motor, sensory, autonomic, or combinations of those nerve types. The effects usually increase over time. For example, if the myelin sheet that covers nerves slowly deteriorates, the physical symptoms will slowly increase over time. People who look healthy begin to show subtle signs of weakness and dysfunction. Simple tasks become more difficult, especially if they involve repetitive fine motor control such as knitting or writing. Over time the myelin continues to degenerate and the physical effects become more prevalent to an observer.

Sensory neuropathies are more subtle. It may start as a subtle irritation that feels like a rash or irritation on the skin. The burning or tingling sensation increases over weeks to months. Usually people begin to search webmd or consult their doctors. Medicine may be prescribed to help control the sensations. Other prescription drugs may help with the inflammation and irritation around the nerves but damage to the nerve fiber continues over time. Medications are trying to control the symptoms and have little effect on preventing the nerves deterioration.

Evaluating Neuropathy Symptoms

When a patient first begins developing peripheral neuropathy symptoms, a complete clinical examination will be performed to achieve a proper diagnosis. It will begin with a simple history of past exposure to toxic chemicals, metabolic changes, inherited diseases, family health problems, or exposure to lyme disease. Advanced testing can be included to evaluate nerve function including NCV, or a test that measures the health and function of motor and sensory nerves. Blood work will be performed to evaluate possible metabolic or immune system changes that could be causing the neuropathy. Additional advanced testing such as CAT scans or MRIs can be performed to evaluate the possible causes and affected body tissues.

Make sure to bring your medication list with you to your appointment, as many medications can also increase the risk and likelihood of developing forms of peripheral neuropathy. Alcoholic neuropathy is another peripheral neuropathy that develops from chronic alcoholism.

Infections can also cause nerve damage and destroy nerve axons, resulting in neuritis. The infection usually develops in adjacent tissue and spreads to the nearby nerves. The condition can become serious and painful in a short period of time. Your physician will prescribe rest along with oral steroids and narcotic medications for the nerve pain, if necessary. More information on neuritis from Mayo Clinic.

Trigeminal neuralgia is another condition that affects nerves in the face. Severe pain, burning, tingling, and stabbing occurs along the nerve distribution of the trigeminal nerve. Some patients describe the condition as a lighting shock in the face.

Medical Neuropathy Treatment Options

Painful diabetic peripheral neuropathy, idiopathic, toxic, and alcoholic neuropathy all respond differently to medical and conservative treatments. Each neuropathy has a different cause and development of symptoms, and it should be expected that each will respond differently to different types of treatment. Numerous clinical trials have been performed showing the benefits of managing symptoms with several types of prescription medications.

There are multiple causes for peripheral neuropathy, which is why many people react differently to the prescription treatments. In many cases we are unsure of the exact reason for the pain, numbness, tingling, or temperature sensitivity changes that you are experiencing. Some patients respond better to medication changes such as anti-depression or seizure medications, which have shown positive outcomes in some people.

If diabetes is involved, significant diet, exercise, and medication changes can be expected. Blood sugar levels need to be monitored and improved to limit the progression of painful diabetic symptoms. Patient education has to stress the importance of monitoring blood sugar to slow the deterioration of nerve fibers; and therefore, symptoms of peripheral neuropathy. Antidepressant medications are commonly used to help patients with severe painful peripheral neuropathy, since severe constant pain often leads to depression.

Television commercials and newspaper ads are filled with treatment options for "managing nerve pain." Painful diabetic neuropathy symptoms can be improved with proper management of diabetes first and foremost. Medications for pain symptom management helps "manage the nerve pain." Damage to the peripheral nervous system occurs with prolonged elevated blood glucose levels, and properly managing blood sugar levels will help slow the progression of nerve damage and pain. Not all people with diabetic neuropathy have their symptoms isolated to the peripheral nervous system, as damage is likely to spread to the autonomic visceral nervous system. Prescription medications can also help manage these neuropathic pain symptoms.

Conservative & Alternative Treatment Options

Conservative treatment for peripheral neuropathy provides significant relief. Some patients respond to exercise and balance training; specifically activities and exercise that increase blood flow and nerve signal generation, which increases the daily use and amount of nerve signal produced by the nerve. When nerves are activated with regularity, it triggers metabolic and cellular reactions for the nerve to enhance its axon regeneration and repair. Patients with peripheral neuropathy often find their symptoms are decreased when they are more active, and these patients respond to specific exercises developed for neuropathy patients.

Acupuncture and dry needling are alternative treatments that are growing in popularity as patients begin to experience the benefits of these treatments. Very small, sterile needles are placed in specific locations to stimulate the body’s repair and healing processes.

Cold Laser Therapy for Peripheral Neuropathy

Low-level light therapy or cold laser therapy has shown significant improvement in nerve cell regeneration and repair. Specific wavelengths and frequencies enhance functions within the cell to increase its energy and repair mechanisms, which are often compromised in patients experiencing neuropathy symptoms. Multiple studies have shown significant improvement and reduction of symptom intensity, frequency, and duration of pain. Studies have also shown improved nerve sensory function in many patients. Nerve injuries are very difficult to treat and cold lasers are a very effective treatment therapy.

Low-level laser therapy is a newer treatment for peripheral neuropathy symptoms. It has shown significant improvement because of the changes it makes on the small pain nerves, sensory nerves, and motor neurons in the hands and feet. Cold lasers are used in medical clinics to improve muscle weakness and enhance the nerves’ ability to transmit signals, especially in carpal tunnel syndrome and other nerve entrapment disorders. Conditions that involve compressing peripheral nerves respond very well to low-level lasers, which helps with decreasing the inflammation contributing to the compression.

Vibration therapy enhances the nerve stimulus and input up to the brain. The sensory nerves are prepared for receiving more stimulus and transferring that signal up the nerve to the spinal cord. The brain and spinal cord send more signals down the motor neurons to the feet and legs. The increased amount of nerve usage further enhances cellular repair and metabolic activities within the affected nerves. Vibration therapy is often used with professional athletes to enhance their neuromuscular control to improve athletic performance.

Combining class IV cold laser with vibration therapy further enhances patient improvement and recovery from peripheral neuropathy. These combined treatments can significantly decrease the pain intensity, timing, frequency, and duration, as well as decrease numbness and tingling. Within three weeks most patients report a positive result from the treatment and also find the intensity of symptoms is reduced between 25 and 50%.

Peripheral neuropathy treatments can be effective at lessening the symptoms of neuropathy. Not all patients will respond to low-level laser therapy and vibration therapy treatments, but it makes a significant impact in many people's lives.

Changes in footwear are also helpful to decrease the pressure or negative stimulation on the feet. Changing lifestyle diet and alcohol intake can also be very helpful for many people with neuropathic disorders.